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Good Faith Payment Review

Network and non-network providers who receive claim recoupment requests from Health Net Federal Services, LLC (HNFS) due to patient eligibility may ask for a good faith payment review. HNFS performs good faith payment reviews for the following situations:

  • An ineligible patient holds an ID card showing TRICARE eligibility and the provider exercised reasonable care in accepting the ID card as evidence of eligibility.
  • An ineligible patient enrolls in TRICARE Prime and there is documented evidence the patient showed as Prime-eligible in the Defense Enrollment Eligibility Reporting System (DEERS) on the date care was rendered.

Requests must be postmarked or received by HNFS within 90 days of the date on the beneficiary’s TRICARE Explanation of Benefits, the provider remittance or refund request.

Include the following with your payment review request:

  • letter with the reason for requesting the review
  • copy of the claim if available
  • copy of the Explanation of Benefits or provider remittance
  • a copy of the TRICARE ID card
  • copy of screen shot displaying eligibility
  • proof of billing statement sent to the beneficiary greater than 30 days from the date of the request
  • any other documentation that the provider collected before providing the service

Mail or fax the request to:

TRICARE West – Priority Correspondence
PO Box 202101
Florence, SC 29502-2101

Fax: 1-844-869-2811